Harmon, Michael NEW YORK STATE DEPARTMENT OF HEALTH4: S gs
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael J Harmon Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/20/2018 67 Years War Or Dates 1970-1974
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Maria Vivenzio DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 547
❑Burial
Date Cemetery or Crematory
10/22/2018 Pine View Crematory
❑Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
0,4 and/or Address
Hold
El i Date Point of
Transportation Shipment
by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
El Reinterment Date Cemetery Address
.; Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
gg
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/22/2018 Registrar of Vital Statistics John T Eranck(E1ectronically Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
'{ Date of Disposition /0 inin Place of Disposition fn4,--/ r dor...,
in (address)
ili
CO
(section) (lot nu er) (grave number)
pName of Sexton or Person in Charge of Premises (r„ r StAn tit
(please print)
Signature Title fireflITK.
(over)
DOH-1555(02/2004)